Audit of pain management at home following tonsillectomy in children

The pain experienced at home and the burden this places on primary care resources is considerable following tonsillectomy in children. This was audited by postal questionnaire in 52 patients (36 responders). We found a significant proportion of patients experiencing moderately severe to severe pain and a high rate of consultation with general practitioners (50 per cent) for pain-related issues. These findings lead to changes in practice which included the provision of five days discharge medication (paracetamol/ibuprofen in non-asthmatics; paracetamol/dihydrocodeine in asthmatics) and improved written discharge advice. On re-auditing a year later in 100 patients (56 responders), we found reduced rates of consultation with general practitioners (27 per cent). However, the proportion of children experiencing moderately severe to severe pain was not reduced probably because most children were given the recommended analgesia during the first audit. We also found that paracetamol and ibuprofen was superior to paracetamol and dihydrocodeine for analgesia (p<0.05). Suggestions for further improvements are discussed.